Leveraging a Consumer-Based Product to Develop a Cancer-Specific Mobile Meditation App: Prototype Development Study

Background Mobile meditation apps may offer a long-term, accessible, and effective solution for ongoing symptom management in cancer patients/survivors. However, there are currently no commercial cancer-specific meditation apps that reflect cancer specialist expertise, input from cancer patients/survivors, and features and content specific to cancer patients’/survivors’ needs. Objective The aim of this study was to gain insight (via surveys, daily journals, and focus groups) from cancer patients/survivors, health care providers, and current subscribers of Calm (a consumer-based mobile meditation app) who were patients/survivors to develop a prototype of a mobile meditation app specifically designed for cancer patients/survivors. Methods Participants were recruited via prior partnerships, word-of-mouth referrals, and recruitment posts on Facebook and Instagram. Cancer patients/survivors and health care providers were instructed to download and use the Calm app for at least 10 minutes a day for 7 days, complete an online daily journal for 7 days, and participate in a virtual focus group (one for cancer patients/survivors and one for providers). Current Calm subscribers who were cancer patients/survivors completed an online survey about different aspects of the Calm app and participated in a third virtual focus group. Data were qualitatively analyzed using a combination of deductive and inductive coding. Results A total of 27 participants (11 cancer patients/survivors, 10 health care providers, 6 current Calm subscribers) completed the study. Similar themes and subthemes were found across surveys, daily journals, and focus groups, and fell into two major categories, content and functionality, with cancer-specific and noncancer-specific themes identified within each category. The majority of content preferences and suggestions that arose were cancer-specific, such as content related to negative emotions or feelings (eg, anxiety, grief, trauma/posttraumatic stress disorder, fear of recurrence, isolation), positive feelings and finding meaning (eg, gratitude, storytelling, acceptance), scenarios and experiences (eg, waiting, treatment-specific mediations), type and stage of cancer journey, and movement modifications. Some of the noncancer-specific themes under app content included sleep, music, and visualizations. In terms of app functionality, the majority of participants expressed interest in having a section/tab/area of the app that was specifically geared toward cancer patients/survivors. Preferences and suggestions for cancer-specific functionality features included options based on symptoms or journey, being able to communicate with other patients or survivors to share suggestions for specific meditations, and having an emergency toolkit for patients/survivors. Conclusions Findings from cancer patients/survivors, health care providers, and current Calm subscribers who were patients/survivors to be incorporated into the development of the prototype fell into two major categories: (1) content of the app and (2) functionality of the app. The prototype’s form and function will be pilot-tested among 30 cancer patients/survivors in a 4-week study, and the resulting feasibility data will be used to inform the final app design and an efficacy study.

A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study

Background Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant.

Using Facebook Advertisements for Women’s Health Research: Methodology and Outcomes of an Observational Study

Background Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. Objective A Qualtrics survey was fielded to ascertain women’s knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. Methods Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. Results In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). Conclusions Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations.

Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial

Background Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Methods Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Results A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help–seeking. Conclusions Use of the peer support app was related to reduced NSSI frequency and greater confidence in one’s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help–seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration Open Science Foundation; https://osf.io/3uay9

Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study

Background Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods This study involved 2 iterative design feedback cycles—an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools.

Continuous Monitoring of Vital Signs With Wearable Sensors During Daily Life Activities: Validation Study

Background Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients’ baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making. Objective The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment. Methods Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA). Results A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (−0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of −39.0 to 28.3) bpm and 11.4 (LoA of −53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (−10.8 to 10.4 breaths/min) for RR, underestimated SpO2 (>1%), and overestimated temperature up to 2.9 °C. Conclusions Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring.

The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration

Background Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease–related health barriers and the users’ confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management.

Feasibility of Monitoring Health and Well-being in Emerging Adults: Pilot Longitudinal Cohort Study

Background Emerging adulthood is a distinct segment of an individual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. Objective The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. Methods This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the sample, completeness of the survey responses, and data linkage characteristics. Results Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). Conclusions The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. Trial Registration Australian New Zealand Clinical Trials Registry number ACTRN12618001364268; https://tinyurl.com/teec8wh International Registered Report Identifier (IRRID) RR2-10.2196/16108

Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review

Background The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors. Objective This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions. Methods Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research. Results Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents. Conclusions Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention.

A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study

Background Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary.